Merit-Based Incentive Payment System (MIPS) and Advance Alternative Payment Model (APM)

Time Sensitive: October 1, 2017 Deadline

CMS has contracted with the Physician Value Help Desk, Million Hearts, to conduct education and answer inquiries regarding MIPS and the Quality Payment Program (QPP). Noridian is providing basic information, resources and related hyperlinks to help redirect providers to the proper entities administering the programs.

Note: Noridian is unable to assist with education or answer inquiries on this topic beyond referring providers to the available resources.

The QPP helps providers focus on care quality and managing for healthier patients. The QPP ends the Sustainable Growth Rate formula and provides new tools for eligible providers, models and resources to help provide the best possible care for your patients. Choose how to take part based on practice size, specialty or patient population with these two (2) tracks.

  1. Merit-based Incentive Payment System (MIPS)
  2. Advanced Alternative Payment Model (APM)

Merit-based Incentive Payment System (MIPS)

View MIPS overview.

Four MIPS measurement criteria areas

  1. Performance Quality
  2. Cost
  3. Improvement Activities
  4. Advance in Care

These measurements are comparable to retired programs such as; Electronic Health Records (Meaningful Use), Electronic Prescribing, Physician Quality Reporting System (PQRS) and the Value Based Modifier (VM).

Determine MIPS Participation Status

  • Enter provider 10-digit National Provider Identifier (NPI) within the MIPS Participation Tool
  • Results will display in a table similar to below
Clinician Name Address Individual Group
Physical Therapy Street, City, State, Zip Exempt from MIPS Exempt from MIPS
Physician Street, City, State, Zip Included in MIPS Included in MIPS


  • Clinician action needed in 2017
    • Pick Pace and chose Test, Partial or Full Participation

Advanced Alternative Payment Model (APM)

View APM Overview.

  • Approved entities participate under agreement with CMS
  • Performance models include
    • Comprehensive Primary Care Plus (CPC+)
    • Next Generation ACO
    • Oncology Care Model (OCM)
    • Shared Savings Program Tracks 1, 2, 3
    • Comprehensive ESRD Care (CEC)
  • Potential additional payment +5% lump sum bonus of covered Part B claims


  • Practice bills Medicare claims for more than $30,000 annually and/or cares for more than 100 Medicare patients

Exempt from MIPS/APM Programs

  • Providers (MD, DO, DMD, DC, DPM, PA, NP, CNS, CRNA) billing less or equal to $30,000 Part B allowed charges or 100 or less Medicare patients annually
  • Newly graduated from a program or not enrolled as Medicare provider

Obtaining Quality and Resource Use Reports (QRUR) - Physician Value Help Desk

  • Monday - Friday: 8 am - 8 pm ET
  • Phone: 888-734-6433, press option 3
  • Fax: 469-372-8023
  • Email:



Last Updated Mon, 19 Dec 2022 18:44:16 +0000